Arkansas: Relax! GOP's Medicaid work requirements are "working" exactly the way they hoped.

Over at the Washington Post, Catherine Rampell has an article which confirms EVERYTHING that I and other healthcare wonks have been warning about for months (or years) regarding the real-world impact of imposing work requirements for Medicaid expansion recipients:

...For many low-income families, the Arkansas experiment has already proved disastrous. More than 12,000 have been purged from the state Medicaid rolls since September — and not necessarily because they’re actually failing to work 80 hours a month, as the state requires.

...McGonigal, like most non-disabled, nonelderly Medicaid recipients, had a job. Full time, too, at a chicken plant.

...More important, McGonigal’s prescription medication — funded by the state’s Medicaid expansion, since his job didn’t come with health insurance — kept his symptoms in check.

...Like many I spoke with, McGonigal says he got confusing and sometimes conflicting information from the state’s Department of Human Services, which told him to report online. He doesn’t have a cellphone or computer, so he borrowed his sister-in-law’s smartphone.

...The state wanted him to report monthly. He learned this only when his pharmacy told him his insurance had been canceled. After that, he couldn’t afford his medication. His COPD flared up and he landed in the emergency room. And he missed lots of work.

“I tried to stick it out, and still go to work, but I just couldn’t do it,” he said. Ultimately, reluctantly, his supervisor let him go.

In other words: A policy intended to help people get jobs instead cost McGonigal his.

The article goes no to note that:

  • You can only report your hours via the website, in a state which...
  • ...has the lowest level of household internet access in the country, using a website which...
  • ...doesn't work properly on smartphones, and...
  • taken offline from 9pm - 7am every night for no discernable reason.

This isn't just a matter of incompetence, mind you: Kicking thousands of people off their healthcare coverage is the entire point. All the nonsense about "empowering people to find the dignity of work" bla bla bla is and has always been a pile of garbage.

Don Moynihan, a public management professor at Georgetown University, posted a thread on Twitter this morning which nails the situation:

30 percent of Medicaid adults report they never use a computer, 28 percent say they do not use the internet, and 41 percent do not use email. It is unrealistic to expect that such a population will possess the technological literacy to navigate online documentation processes

— Don Moynihan (@donmoyn) November 20, 2018

The level of cruelty needed to support a system that will take health coverage from a homeless person trying to find work is hard to fathom. What is worse, CMS and others describe such processes as "empowering" workers

— Don Moynihan (@donmoyn) November 20, 2018

If work requirements were a good faith effort to help people, you would expect states to invest some resources & make it easy for people to report. If work requirements were a de facto exercise to limit access to health insurance, you would expect to see this (via @crampell)

— Don Moynihan (@donmoyn) November 20, 2018

Another example of how work requirements will hurt certain groups, such as those in seasonal labor or self-employed. Is the self-employed landscaper supposed to get a receipt for each lawn that he mowed? (From

— Don Moynihan (@donmoyn) November 20, 2018

There's another article in the Arkansas Times which goes into further detail about just how terrible the situation in Arkansas is.

Similar work requirement waivers have been approved in Indiana, New Hampshire and Wisconsin, and are pending in Alabama, Arizona, Kansas, Maine, Mississippi, Ohio and South well as my own state of Michigan. A waiver was approved for Kentucky last spring, but has been (temporarily?) invalidated by court order, while a pending waiver in Utah has been rendered moot by the passage of Proposal 3, which includes "full" Medicaid expansion.

UPDATE: As Harris Meyer reminds me, while the midterm elections should mean the addition of ACA Medicaid expansion in three red states (Utah, Idaho and Nebraska), existing expansion could be at risk in two other states as a result: Alaska and Montana:

Medicaid expansion in Alaska, Montana threatened by midterm results

Medicaid expansion in Alaska and Montana potentially could be rolled back or repealed as a result of Tuesday's midterm election results.If that happens, it would be the first time the extension of coverage to low-income adults under the Affordable Care Act was ever reversed. That prospect alarms expansion supporters, who cite numerous polls and successful ballot initiatives as evidence that the public strongly supports Medicaid expansion, even in conservative states.

The full story is behind a paywall, but here's the gist:

  • In Montana, the existing expansion program was only funded for three years in 2015, and is set to expire next June, I believe, unless funding is extended one way or the other. A ballot initiative which would have funded the program via an additional tax on tobacco products failed, so now the clock is ticking for 90,000 people.